Hypersensitivity reactions to carboplatin in children with low-grade gliomas

The prognosis of pediatric low-grade gliomas is relatively favorable, but unresectable progressive tumors remain a challenge. Chemotherapy including carboplatin-containing regimens can delay the need for radiation therapy in young children. However, hypersensitivity reactions to carboplatin can at times be a severe complication. We have retrospectively evaluated and characterized the hypersensitivity reactions associated with carboplatin administration in pediatric low-grade glioma patients treated on an outpatient basis according to the SIOP/GPOH (International Society of Pediatric Oncology/ Gesellschaft fur Padiatrische Onkologie und Hamatologie) low-grade glioma 1996 protocol, and also reviewed the literature. Of nine patients consecutively treated with carboplatin, seven (78%) developed carboplatin hypersensitivity reactions. The first hypersensitivity reactions (always grade 2) occurred after a median of nine courses (range, 7-12). Although desensitization has been used successfully, there have been reports of severe cases of allergic reaction to carboplatin despite desensitization, including anaphylaxis and death. Since carboplatin hypersensitivity reactions are common and desensitization has not been proven to be safe, efforts should be made to design future therapy protocols for low-grade gliomas with clear guidelines on how to substitute carboplatin when hypersensitivity reactions occur. (J Pediatr Neurol 2004; 2(3): 151-155).